Communication in the context of glioblastoma treatment: A qualitative study of what matters most to patients, caregivers and health care professionals.

BACKGROUND: Patients with glioblastoma have a poor prognosis and treatment is palliative in nature from diagnosis. It is therefore critical that the benefits and burdens of treatments are clearly discussed with patients and caregivers. AIM: To explore experiences and preferences around glioblastoma treatment communication in patients, family caregivers and healthcare professionals. DESIGN: Qualitative design. A thematic analysis of semi-structured interviews. SETTING/PARTICIPANTS: A total of 15 adult patients with glioblastoma, 13 caregivers and 5 healthcare professionals were recruited from Leeds Teaching Hospitals NHS Trust. RESULTS: Four themes were identified: (1) Communication practice and preferences. Risks and side-effects of anti-tumour treatments were explained clearly, with information layered and repeated. Treatment was often understood to be 'the only option'. Understanding the impact of side-effects could be enhanced, alongside information about support services. (2) What matters most. Patients/caregivers valued being well-supported by a trusted treatment team, feeling involved, having control and quality of life. Healthcare professionals similarly highlighted trust, maintaining independence and emotional support as key. (3) Decision-making. With limited treatment options, trust and control are crucial in decision-making. Patients ultimately prefer to follow healthcare professional advice but want to be involved, consider alternatives and voice what matters to them. (4) Impact of COVID-19. During the pandemic, greater efforts to maintain good communication were necessary. Negative impacts of COVID-19 were limited, caregivers appeared most disadvantaged by pandemic-related restrictions. CONCLUSIONS: In glioblastoma treatment communication, where prognosis is poor and treatmentwill not result in cure, building trusting relationships, maintaining a sense of control and being well-informed are identified as critical.

Total Synthesis of (-)-Salvinorin†A.

Salvinorin A (1) is natural hallucinogen that binds the human κ-opioid receptor. A total synthesis has been developed that parlays the stereochemistry of l-(+)-tartaric acid into that of (-)-1 via an unprecedented allylic dithiane intramolecular Diels-Alder reaction to obtain the trans-decalin scaffold. Tsuji allylation set the C9 quaternary center and a late-stage stereoselective chiral ligand-assisted addition of a 3-titanium furan upon a C12 aldehyde/C17 methyl ester established the furanyl lactone moiety. The tartrate diol was finally converted into the C1,C2 keto-acetate.

A stereoconvergent intramolecular Diels-Alder cycloaddition related to the construction of the decalin core of neo-clerodane diterpenoids.

Several examples of a highly specific, stereoconvergent intramolecular Diels-Alder cycloaddition that led to the trans-decalin core of neo-clerodane diterpenoids are described. The relative configuration adjacent to the dienophile, which led to C4 of the decalin system, as well as the electron-withdrawing effects of various substituents and conformational rigidity of the Diels-Alder precursors were explored.

Injectate volumes needed to reach specific landmarks in s1 transforaminal epidural injections.

OBJECTIVES: We identify the contrast volumes needed to reach specific landmarks during S1 transforaminal epidural injections (S1-TFEIs). DESIGN: Prospective, nonrandomized, observational human study. Setting. Academic/private pain management practice. Subjects. Forty-two patients undergoing S1-TFEIs were investigated. Thirty-seven patients were included in this study. Interventions. S1-TFEIs were performed using contrast-enhanced fluoroscopic visualization. MAIN OUTCOME MEASUREMENTS: After confirming appropriate spinal needle position, up to 5 mL of nonionic contrast was slowly injected. Under biplanar fluoroscopic guidance, contrast volumes were recorded as flow reached specific anatomic landmarks: the ipsilateral S1 pedicle, the superior aspect of the L5-S1 disc space, and across the midline of the spinous process. RESULTS: After injecting 2 mL of contrast, 100% of S1-TFEIs spread to the medial aspect of the ipsilateral superior pedicle of S1. After injecting 3.0 mL of contrast, 92% of S1-TFEIs spread to the superior aspect of the L5-S1 intervertebral disc. After injecting 4 mL of contrast, 27% of S1-TFEIs spread beyond the midline of the spinous process, but by only a few millimeters. CONCLUSIONS: This study demonstrates injectate volumes needed to reach specific anatomic landmarks in S1-TFEIs. A volume of 3.0 mL of contrast reaches the superior aspect of the L5-S1 intervertebral disc 92% of the time.

Mixed emotions: holistic and analytic perception of facial expressions.

In the face literature, it is debated whether the identification of facial expressions requires holistic (i.e., whole face) or analytic (i.e., parts-based) information. In this study, happy and angry composite expressions were created in which the top and bottom face halves formed either an incongruent (e.g., angry top + happy bottom) or congruent composite expression (e.g., happy top + happy bottom). Participants reported the expression in the target top or bottom half of the face. In Experiment 1, the target half in the incongruent condition was identified less accurately and more slowly relative to the baseline isolated expression or neutral face conditions. In contrast, no differences were found between congruent and the baseline conditions. In Experiment 2, the effects of exposure duration were tested by presenting faces for 20, 60, 100 and 120 ms. Interference effects for the incongruent faces appeared at the earliest 20 ms interval and persisted for the 60, 100 and 120 ms intervals. In contrast, no differences were found between the congruent and baseline face conditions at any exposure interval. In Experiment 3, it was found that spatial alignment impaired the recognition of incongruent expressions, but had no effect on congruent expressions. These results are discussed in terms of holistic and analytic processing of facial expressions.

Fatigue reporting among aircrew: incidence rate and primary causes.

INTRODUCTION: In this study we describe our experience of voluntary fatigue reporting among pilots and cabin crew. METHOD: This was a prospective study to determine the crude incidence rate and primary cause of fatigue report form submission among cabin crew and pilots within one airline. All crew duties had already undergone scrutiny at the 'roster build' stage to ensure compliance with fatigue control measures. Reports were investigated by the airline's medical officer to determine the primary cause of fatigue and then allocated to one of five categories. The frequency and proportion of reports within each category was determined. RESULTS: The crude incidence rate of fatigue report submission was 103 and 68 cases per 1000 persons per year for pilots and cabin crew, respectively. The primary cause for 27% of reports was attributed to the rostered duty pattern. Of the reports, 24% were primarily caused by roster disruption, 17% by problems with layover accommodation or transport, 23% by a domestic issue, and 9% had no obvious cause or were deemed invalid. A subanalysis of the 'domestic' category revealed that half had a primary cause attributable to commuting to or from the workplace. CONCLUSION: The number and trend of reports received per month can be used to detect otherwise unknown fatigue hazards and identify where improvements can be made. Fatigue reports allow individual crewmembers to give vital feedback on 'whole-of-life' fatigue risks, both inside and outside the workplace.

Enolization regioselectivity involving stereoisomeric 4a-methyl-5-methoxyperhydrobenzo[7]annulen-2-ones.

Efficient synthetic routes to the four isomers 17b-20b of the title ketone are described. Entry begins from the Wieland-Miescher homologue 3 whose pair of carbonyl groups are amenable to regiochemical manipulation. The compositions of the reaction mixtures generated under kinetic or thermodynamic control were defined by (1)H NMR analysis subsequent to chromatographic purification. The regiochemical trends are correlated with B3LYP/6-31G* calculations, the results of which conform to the preferred introduction of a 1,2- or 2,3-double bond.

Emotional reactivity to social rejection versus a frustration induction among persons with borderline personality features.

This laboratory study examined the emotional reactivity of persons with heightened borderline personality (BP) features to a social rejection stressor. Participants with high levels of BP features (n = 43) and controls with low levels of BP features (n = 67) were randomly assigned to a condition involving negative evaluation and social rejection based on personal characteristics, or to a condition involving a frustrating arithmetic task and negative evaluation based on performance. Hypotheses were that the high-BP individuals would demonstrate greater increases in negative emotions, shame, and anger in response to the social rejection/negative evaluation stressor, compared with the frustrating arithmetic task. The high-BP group showed significant increases in negative emotions in both conditions, significant increases in shame only in the frustrating arithmetic task, and significant increases in hostility only in the social rejection condition. In contrast, low-BP controls showed significant increases in negative emotions generally in the frustrating arithmetic condition and shame specifically in the social rejection condition. These findings highlight the emotion and context-specific nature of emotional reactivity in relation to BP features.

How often, or how many ways: clarifying the relationship between non-suicidal self-injury and suicidality.

This study clarified the association of maladaptive, potentially self-damaging behaviors with suicidality. Specifically, we examined whether greater frequency (i.e., how often) or greater versatility (i.e., how many ways) of several self-damaging behaviors, including non-suicidal self-injury (NSSI), substance use, and disordered eating, increased risk for suicide. Participants who engaged in NSSI (N = 142) completed questionnaires assessing suicidal and self-damaging behavior at baseline and engagement in suicidal behaviors (e.g., ideation, attempts, talking about suicide) 3 months later. Results suggest that the versatility rather than frequency of self-damaging behaviors is most robustly associated with suicide risk. Engaging in multiple methods of NSSI and using a greater number of illicit substances were positively associated with suicide risk. Further, versatility of NSSI interacted with depression to predict suicide risk at 3-month follow-up such that highly depressed participants who engaged in more methods of NSSI exhibited highest risk, whereas those who engaged in more methods with low depression exhibited the lowest risk.

Recognizing famous people.

In daily life, face identification requires that the observer select a single representation from hundreds if not thousands in memory. This breadth of choice is nearly impossible to replicate in the laboratory using newly learned faces, especially in the context of a Bubbles experiment (Gosselin & Schyns, 2001). In this study, we obviated this concern by studying the performance of observers in a face-naming task using 210 faces of celebrities. On each trial, we presented a face randomly sampled with Bubbles. We performed least-square multiple linear regressions on the location of the samples and on accuracy to pinpoint the facial features that were used effectively in this task. Correct face identification relied primarily on the eye areas in spatial frequency bands ranging from 4.37 to 70 cycles per face (cpf) and on the mouth and the nose in a spatial frequency band ranging from 8.75 to 17.5 cpf. A comparison with other studies (Caldara et al., 2005; Schyns, Bonnar, & Gosselin, 2002) in which Bubbles was used with a set of 10 newly learned faces revealed that although the eye areas were useful across studies, the mouth area and higher spatial frequencies gained in importance when few newly learned faces were used.

A review of the evaluation and management of syncope in the acute medical unit.

Syncope is a common acute presentation and frequently results in hospitalisation. Cardiac syncope is potentially life threatening. The diagnosis and management of syncope demands a careful history, witness account wherever possible, and a comprehensive assessment. This, in combination with routine investigations, will provide an answer in a significant percentage of patients.